Endocrine

Question 1

Hypothyroidism prev

Answer 1

5-8X more common in females

• over hypothyroidism : 0.1-2%
• subclinical hypo more common 4-10%

Question 2

S&S of hypothyroidism

Answer 2

Galactorrhea 🥛 
Pleural/ pericardial effusions
Ascites 
Carotenemia 
Decreased hearing 
Enlargement of the tongue 👅

Question 3

Drugs impairing thyroid function

Answer 3

Lithium 💊

- Amiodarone ♥️

Question 4

Effect of dopamine on prolactin & TRH

Answer 4

Dopamine inhibits both prolactin and TRH ( so lowers TSH )

So dopamine ANTAGONIST will
⬆️⬆️ will increase the TSH 

Question 5

Lowers serum TSH

Answer 5

Dopamine agonists, glucocorticoids, somatostatin ,

In early pregnancy 🤰 ( high level of chorionic gonadotropin )

Question 6

High serum TSH?

Answer 6

Dopamine antagonist
Amiodarone
Adrenal insufficiency

Question 7

Hashimoto’s thyroiditis

Answer 7

Pathological feature is lymphocytic infiltration,

• serological finding is high serum concentration of TPO and thyroglobulin 

Question 8

Most bothersome symptom of hypothyroidism?

Answer 8

FATIGUE

Question 9

Levothyroxine

Answer 9

The initial dose is 1.6mcg/Kg

For young healthy adult : u can start at 50

Elderly 🧓 start : low as 25 mcg

For short period of hypothyroidism like 2 months:
Take two-third of the anticipated dose

TIMING ⏱

• empty stomach
• before breakfast 🍳 30-60min
• TSH should be re-evaluated at 4-6 weeks
• if TSH above 🎯 target ? Increase dose by 25 mcg in older pt or higher young
• pt require repeat 🔁 TSH. 6 weeks

Question 10

Factors that increase the requirement for T4 ( to increase the dose ⬆️🤩) 

Answer 10

• pregnancy 🤰
• Estrogen therapy
• taking med : phenytoin , carbamazepine
• malabsorption: IBD, celiac ,
• weight gain
• symptoms persists

Question 11

Decrease in dose T4 may be required in the following setting

Answer 11

Normal aging

• weight loss more than 10%
• ANDROGEN therapy 🥴🥷🏼

Question 12

Indication for non-pregnant adults with subclinical hypothyroidism ( T4 N , TSH⬆️) 

Answer 12

1- if the TSH >_10 ? Give T4💊

2- if TSH 7-9.9 ?

• age 65-75? GIVE. T4 💊
• age more than 65-75 ? If there is symptoms give !⚠️

3- TSH level upper limit of normal to 6.9 ?

• age 65-75 ? Observe ( tx not recommended bc normal aging ) ❌
• age less 65-75? If there is symptoms give T4 💊

Question 13

Increase T4 requirements in pregnancy

Answer 13

As 🤰 early as 5th week

Question 14

Management of hypothyroidism and pregnant women

Answer 14

TSH pregnant 🤰 specific ranges

1- if TSH upper normal limit - 2.5 ? Tx not indicated

2- TSH is 2.6-4 ? * 🎯 test for TPO
If +ve ; treat T4
Negative? No need

3-TSH >4 ?
🎯 next step check ( T4) 🟡
*T4 normal? Subclinical ? Give intermediate dose of T4
* T4 low ? Over ? Give Full dose

Question 15

Diagnostic workup for hyperthyroidism

Answer 15

1- signs 🪧 & symptoms?
The. 2 - check TSH levels
🔻 if TSH low , T4 elevated

2- next do radioactive ☢️ iodine uptake & US

Question 16

Radioactive iodine ☢️ uptake scan result

Answer 16

1- low uptake ?

• exogenous/ ectopic T4
• thyroiditis

2- high uptake ?

• homogeneous? Graves Dis🟣
• single nodule ( toxic adenoma) Plummer 🔨 syndrome

*toxic multinodeulor goiter

Question 17

Mx of. Hyperthyroidism

Answer 17

Graves: mithmazole / PTU ,
Radioactive ☢️ iodine ablation
Thyroidectomy

Toxic adenoma/ multinodular goiter ?
Main treatment-option is surgery or ☢️ ablation ,
Medication 💊 will control but No hyperthyroidism remission

Thyroiditis
Usually transit SELF-limiting within 6️⃣ months .

Pain mx : NSAIDS ,
For adrenergic symptoms? BETA-blocker propranolol🔰

Question 18

Mx of. Hypercalcemia

Answer 18

• normal saline
• loop diuretics
• Bisphosphonates ( ⚠️ caution of JAW osteonecrosis )
• calcitonin
• parathyroidectomy

Avoid ❌ ( thiazides)

Question 19

Approach for hypercalcemiq ⬆️?

Answer 19

1- test Ca+
High ? 2- corrected Ca to ( confirmed hypercalcemia) 🔰

3- PTH level

• high ? Do 24hr URINE COLLECTION ( ca/Cr ratio)
• 🔻 high ratio ? 1* primary hyperparathyrodism

-🔻 low ratio ? FHH

• PTH level low ? 🪧 test for
  @ PTHrp
  @ Vit D 25
  @ 1.25 Vit D

🟡 high 25 D level ? Vitamin toxicity
🟡 high 1-25 D ? Lymphoma , sarcoid

Question 20

Management of adrenal insufficiency

Answer 20

Give hydrocortisone in a cute hypoadrenal crisis ⛔️⚠️

iF still hypotensive give fludrocortisone since it has the highest mineral glucocorticoids content, ⏱🔰

for stable nonhypertensive give predisone

Question 21

Treatment of hyperaldosteronism

Answer 21

Solitary adenoma,: surgical resection 🔪

Hyperplasia ? Spironolactone